Provider Demographics
NPI:1568419489
Name:HUDE, JILL ELIZABETH (PAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:HUDE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 SITIO DEL RIO BLVD STE D101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1148
Mailing Address - Country:US
Mailing Address - Phone:512-478-3376
Mailing Address - Fax:512-478-3375
Practice Address - Street 1:6618 SITIO DEL RIO BLVD STE D101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1148
Practice Address - Country:US
Practice Address - Phone:512-478-3376
Practice Address - Fax:512-478-3375
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2191Medicare ID - Type Unspecified
TXQ35812Medicare UPIN